Emotional Antecedents of Hot Flashes During Daily Life

Duke University, Durham, North Carolina, United States
Psychosomatic Medicine (Impact Factor: 3.47). 01/2005; 67(1):137-46. DOI: 10.1097/01.psy.0000149255.04806.07
Source: PubMed


Hot flashes are among the most frequently reported menopausal symptoms. However, little is known about factors associated with their occurrence. Moreover, despite the wide use of self-report hot flash measures, little is known about their concordance with physiological flashes. This study evaluated emotional and behavioral antecedents of subjectively and objectively measured hot flashes during daily life. It also examined individual differences predicting concordance between objective and subjective hot flashes.
Forty-two perimenopausal or postmenopausal women (mean age = 50.5 +/- 4.8 years) reporting daily hot flashes completed 2 days of ambulatory sternal skin conductance monitoring, behavioral diaries 3 times an hour, and psychometric questionnaires. Hot flashes meeting objective physiological criteria and subjectively reported flashes not meeting physiological criteria were assessed. Likelihood of hot flashes following emotions and activities were examined in a case-crossover analysis.
Relative to nonflash control times, objective hot flashes were more likely after increased happiness, relaxation, and feelings of control, and less likely after increased frustration, sadness, and stress. Conversely, subjective hot flashes not meeting physiological criteria were more likely after increased frustration and decreased feelings of control. Questionnaires revealed increased negative mood and negative attitudes were associated with fewer objective flashes and higher false-positive reporting rates.
Increased positive and decreased negative emotions were associated with objective hot flashes, whereas increased negative and decreased positive emotions were associated with subjective flashes not meeting physiological criteria. The anecdotal association between negative emotions and hot flashes may be the result of self-reported flashes lacking physiological corroboration.

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    • "At the level of symptom perception, somatic amplification may increase the likelihood of symptom detection [13] [38], but may also increase reporting of HFNS due to a higher sensitivity and selective attention to small variations in thermoregulatory sensations. Few studies have previously examined HFNS symptom perception, but Thurston and colleagues [39] found that women with higher somatization scores were more likely to over-report hot flushes, and in a pilot study we also found that somatic amplification was associated with negative beliefs which in turn predicted HFNS problem-rating [28]. Depressed mood was not associated with increased symptom perception but optimism was (depressed mood and optimism were significantly correlated). "
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    ABSTRACT: Objective Hot flushes and night sweats (HFNS) are commonly experienced by women during the menopause transition and are particularly problematic for approximately 25% having negative impact on their quality of life. We previously developed a cognitive model of HFNS, which outlines potential predictors of HFNS. This study aims to test the model by investigating the relationships between personality characteristics, perceived stress, mood, HFNS beliefs and subjective and physiological measures of menopausal HFNS.Methods140 women (menopause transition or postmenopausal) who were experiencing at least 10 HFNS per week for at least a month, completed assessment interviews, including questionnaires assessing optimism, somatic amplification, perceived stress, depressed mood, anxiety, HFNS beliefs and HFNS frequency, problem-rating and 24-hour sternal skin conductance monitoring. Structural equation models (SEM) were used to investigate the optimum predictive model for HFNS Frequency and HFNS Problem-Rating.ResultsOn average 63 HFNS per week and moderately problematic HFNS were reported. The physiological measure of HFNS frequency was not associated with socio-demographic variables, personality or mood. The final SEM explained 53.2% of the variance in problem rating. Stress, anxiety and somatic amplification predicted HFNS problem rating but only via their impact on HFNS beliefs; HFNS frequency, smoking and alcohol intake also predicted HFNS problem rating.Conclusions Findings support the influence of psychological factors on experience of HFNS at the level of symptom perception and cognitive appraisal of HFNS.
    Full-text · Article · Apr 2013 · Journal of psychosomatic research
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    • "In addition, a literature review has highlighted that psychological interventions might result in a decrease, to a certain degree, of hot flushes' frequency or intensity (Pimenta, Leal, & Branco, 2007). Perceived control has been observed as being associated to a less symptomatic experience in many areas (Doerfler, Paraskos, & Piniarski, 2005;Hoedemaekers, Jaspers, & van Tintelen, 2007;Rivard & Cappeliez, 2007;Schnoll et al., 2011) and, specifically, in relation to the vasomotor symptoms (Reynolds, 1997;Thurston, Blumenthal, Babyak, & Sherwood, 2005). Therefore, it is pertinent to have adapted measures to assert the particular perceived control over hot flushes. "
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    ABSTRACT: Aim: This research aims at validating an instrument to assess the perception of control over hot flushes, frequent symptoms during menopause. Method: A sample of 243 symptomatic women completed the Perceived Control over Hot Flushes Index, PCoHFI (Reynolds, 1997), two subscales from the Menopause Symptoms’ Severity Inventory, MSSI-38 (Pimenta et al., 2011) to assess perceived loss of control and vasomotor symptoms, as well as a socio-demographic questionnaire. The construct, criterion and external validity, reliability and sensitivity were explored. Results: The exclusion of item 15 is suggested since it presents a negative factorial weight (λ = -.105; p = .134) and only 1.1% of its variance is explained by the construct. The PCoHFI manifested two factors: internal and external control attribution. It does not present convergent validity, but it has discriminant validity. Criterion validity is confirmed by a significant correlation with other similar constructs. Moreover, the PCoHFI evidences a good reliability and sensitivity. Conclusion: The PCoHFI manifests good psychometric properties and is an adequate instrument to assess this variable, which has been identified as a strong predictor of vasomotor symptoms’ severity. Research and interventions with women who evidence severe hot flushes can benefit from the assessment of such construct.
    Full-text · Article · Jul 2012
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    • "menstrual cycle irregularities, or hysterectomy without oophorectomy Cross-sectional (two time points) study of relationship between psychological functioning and NS Ambulatory Perimenopausal and postmenopausal Well United States Biolog Model 3991/1-SCL a Diary (retrospective recall upon waking) Sociodemographics, Sleep-Wake Experience List, BDI-II, Daily Stress Inventory, STAI 23. Thurston et al (2005) "
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    ABSTRACT: Sternal skin conductance is considered the gold standard in hot flush and night sweat measurement, but results sometimes differ from women's own self-reports. To date, there has been no systematic review of concordance between sternal skin conductance and self-report measures. An exploratory meta-analysis was conducted to quantify concordance between these measures and to explore the reasons for discordance between them. A search of Medline, EMBASE, Web of Science, and PsychInfo from inception to December 2009 was conducted. Studies that measured self-reported hot flushes and/or night sweats and sternal skin conductance concurrently in symptomatic perimenopausal and postmenopausal women were retained for data extraction. Studies were included if data on concordance between the two measures were available. Concordance rates overall were 29%, but variability between studies was too broad to identify a single typical concordance rate. However, concordance rates for ambulatory monitoring were more homogeneous and also had a 29% concordance rate. Nonambulatory studies tended to result in more concordant hot flushes (54%) than ambulatory studies did, and night sweats tended to be under-reported more often than over-reported (46% and 22%, respectively). Concordance rates were typically lower than early reports of sternal skin conductance measures but were highly variable between studies. Possible measurement error and study conditions might partly explain the discordance and variation in study findings, but further exploration of the effects of symptom perception is warranted. Use of both measures concurrently is likely to achieve more reliable and valid measurement of hot flushes and night sweats than either measure alone.
    Preview · Article · Feb 2011 · Menopause (New York, N.Y.)
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